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CV Risk Reduction in T2D
Cardiology Call to Action: Embracing Glucose-Lowering Treatment to Lower CV Risk in Patients With T2D

Released: October 17, 2023

Expiration: October 17, 2024

Anne Peters
Anne Peters, MD
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Key Takeaways
  • 2023 European Society of Cardiology Guidelines for Managing CVD in Patients with Diabetes include Class I recommendations for both SGLT2i and GLP-1 RA medications with proven CV efficacy as part of a cardiovascular risk reduction program for patients with T2D with or at high risk for ASCVD.

Atherosclerotic Cardiovascular Disease and Heart Failure Risk in Persons With T2D

As cardiologists, why should you care so much about type 2 diabetes (T2D)? According to the American Heart Association, approximately one third of patients with T2D have undetected or asymptomatic atherosclerotic cardiovascular disease (ASCVD). Diabetes has been considered a cardiovascular (CV) or myocardial infarct (MI) risk equivalent for decades, and in the face of rising incidence and prevalence of diabetes, we need to target interventions for our patients with diabetes to reduce their CV risk.

The 2020 American College of Cardiology (ACC) Expert Consensus Clinical Decision Pathway on Cardiovascular Risk Reduction in Persons with Type 2 Diabetes recommends that preventive measures, including medications targeting CV risk reduction, be undertaken in patients with T2D and at least one of the following: clinical ASCVD, heart failure, diabetic kidney disease, or individuals at high risk for ASCVD. Individuals should be treated with a glucagon-like peptide-1 receptor agonist (GLP-1 RA) or a sodium-glucose cotransporter-2 (SGLT2) inhibitor with proven CV benefit. If the patient’s A1C remains above goal despite treatment with either a GLP-1 RA or SGLT2 inhibitor, then you can add on the alternate drug class for further blood glucose control. The 2023 American Diabetes Association Standards of Medical Care in Diabetes also recommend preferential use of antihyperglycemic medications with proven CV benefit as part of a comprehensive CV risk reduction program, and the 2023 European Society of Cardiology Guidelines for the management of cardiovascular disease in patients with diabetes include a Class I indication for GLP-1 RA and SGLT2i for all persons with or at high risk for CV disease, independent of A1C and of background antihyperglycemic therapies. Therefore, it is imperative that cardiologists realize it is imperative to prescribe these evidence-based therapies for cardiovascular risk reduction and considerations completely independent of glucose management.

Providing Care for Patients With T2D and Heart Disease

Most people with diabetes and clinical ASCVD are seen by cardiologists. In an analysis of more than 100,000 people, Gunawan and colleagues found that most individuals with coronary artery disease, heart failure, cerebrovascular disease, and peripheral vascular disease were seen by cardiologists at a higher frequency than an endocrinologist or primary care clinician. This demonstrates the need for cardiologists to rise to the challenge and treat persons with T2D and ASCVD with anithyperglycemic medications that target CV risk reduction such as GLP-1 RAs and SGLT2 inhibitors.

In 2021, Nelson and colleagues used a survey to assess how well SGLT2 inhibitors and GLP-1 RAs were incorporated into the cardiology community. They found that approximately half of cardiologists are aware of the CV benefits of these medications, but only a few cardiologists are routinely prescribing SGLT2 inhibitors or GLP-1 RAs. As discussed, cardiologists see these individuals at a higher frequency than other healthcare providers, and we need to move towards cardiologists routinely prescribing these medications to address ASCVD burden. With the ongoing accumulation of data for SGLT2 inhibitors and GLP-1 RAs, there will be improvement in comfortability using these agents, and increased utilization to improve our patients’ CV risk.

Interested in learning more? Sign up for an upcoming live CME session on GLP-1 RAs and CV risk reduction or view the recorded online webinar.

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In your practice, how likely are you to prescribe GLP-1 RAs to your patient with ASCVD and diabetes?

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